Kaplan Pharmacology Integrated Proctored Exam (Form D)
– NGN Style 70 Practice Questions with 4 Answer Options &
Detailed Rationales
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
Question 1
A nurse is administering intravenous morphine sulfate to a postoperative patient. Which
assessment finding requires immediate action?
A) Respiratory rate of 18 breaths/min
B) Pain rating of 3 on a 0–10 scale
C) Blood pressure 110/70 mm Hg
D) Respiratory rate of 8 breaths/min
Answer: D
Rationale: A respiratory rate of 8 breaths/min indicates respiratory depression, a life-
threatening opioid adverse effect . Naloxone may be needed to reverse this effect. The
other findings are within acceptable ranges; a respiratory rate of 18 is normal, pain of 3
is acceptable, and BP 110/70 is within normal limits.
Question 2
A patient with heart failure is prescribed furosemide 40 mg orally twice daily. Which
laboratory value should the nurse monitor most closely?
A) Serum sodium of 138 mEq/L
B) Serum potassium of 3.1 mEq/L
C) Serum calcium of 9.2 mg/dL
D) Serum magnesium of 2.1 mg/dL
,Answer: B
Rationale: Furosemide is a loop diuretic that causes hypokalemia (potassium loss). A
potassium of 3.1 mEq/L is below the normal range (3.5–5.0 mEq/L) and increases the risk
for cardiac dysrhythmias, especially in patients taking digoxin .
Question 3
A nurse is teaching a patient about digoxin therapy. Which statement indicates
understanding?
A) "I will take an extra dose if I miss one."
B) "I can stop taking digoxin if I feel better."
C) "I will check my pulse daily before taking the medication."
D) "I will take digoxin with antacids for stomach upset."
Answer: C
Rationale: A key nursing responsibility is checking the apical pulse for one full minute
before digoxin administration. Bradycardia (pulse <60/min in adults) requires holding
the dose and notifying the provider. Antacids decrease digoxin absorption .
Question 4
A patient with heart failure is prescribed digoxin. Which finding is most indicative of
digoxin toxicity?
A) Heart rate of 68 bpm
B) Serum potassium of 4.0 mEq/L
,C) Visual changes (yellow-green halos)
D) Weight gain of 2 kg in 24 hours
Answer: C
Rationale: Yellow-green halos (xanthopsia) are classic signs of digoxin toxicity . Other
signs include nausea, vomiting, anorexia, and arrhythmias. A heart rate of 68 bpm and a
normal potassium level do not indicate toxicity.
Question 5
A nurse reviews laboratory reports for a client receiving digoxin and furosemide. Which
laboratory values most concern the nurse?
A) K⁺ 4.5 mEq/L, digoxin 1.0 ng/mL
B) K⁺ 3.2 mEq/L, digoxin 2.2 ng/mL
C) Na⁺ 140 mEq/L, digoxin 1.5 ng/mL
D) Mg²⁺ 2.0 mEq/L, digoxin 0.8 ng/mL
Answer: B
Rationale: A digoxin level of 2.2 ng/mL is above the therapeutic range (0.5–2.0 ng/mL)
and considered toxic. Hypokalemia (K⁺ 3.2 mEq/L) further increases the risk of digoxin
toxicity because low potassium potentiates the effects of digoxin on cardiac muscle .
Furosemide causes potassium wasting, making this combination particularly dangerous.
Question 6
A patient is prescribed atorvastatin for hyperlipidemia. Which statement by the patient
indicates a need for further teaching?
, A) "I should have my liver function tested regularly."
B) "I can continue drinking grapefruit juice with my breakfast."
C) "I should report any muscle pain to my doctor."
D) "I will take my medication at the same time each day."
Answer: B
Rationale: Atorvastatin is metabolized by the CYP3A4 enzyme system. Grapefruit juice
inhibits this enzyme, leading to increased blood levels of the drug and a higher risk of
adverse effects like myopathy and rhabdomyolysis . Patients should avoid grapefruit
juice.
Question 7
A nurse is caring for a client receiving IV vancomycin. Which assessment finding requires
immediate intervention?
A) Mild flushing of the neck and face
B) Tinnitus and complaints of hearing loss
C) Serum creatinine of 0.9 mg/dL
D) Infiltration of the IV site with swelling
Answer: B
Rationale: Tinnitus and hearing loss indicate ototoxicity, a serious adverse effect of
vancomycin that can be irreversible . Red Man Syndrome (flushing) is common but
usually managed by slowing the infusion rate. Creatinine 0.9 mg/dL is normal.
– NGN Style 70 Practice Questions with 4 Answer Options &
Detailed Rationales
SECTION 1: CARDIOVASCULAR PHARMACOLOGY
Question 1
A nurse is administering intravenous morphine sulfate to a postoperative patient. Which
assessment finding requires immediate action?
A) Respiratory rate of 18 breaths/min
B) Pain rating of 3 on a 0–10 scale
C) Blood pressure 110/70 mm Hg
D) Respiratory rate of 8 breaths/min
Answer: D
Rationale: A respiratory rate of 8 breaths/min indicates respiratory depression, a life-
threatening opioid adverse effect . Naloxone may be needed to reverse this effect. The
other findings are within acceptable ranges; a respiratory rate of 18 is normal, pain of 3
is acceptable, and BP 110/70 is within normal limits.
Question 2
A patient with heart failure is prescribed furosemide 40 mg orally twice daily. Which
laboratory value should the nurse monitor most closely?
A) Serum sodium of 138 mEq/L
B) Serum potassium of 3.1 mEq/L
C) Serum calcium of 9.2 mg/dL
D) Serum magnesium of 2.1 mg/dL
,Answer: B
Rationale: Furosemide is a loop diuretic that causes hypokalemia (potassium loss). A
potassium of 3.1 mEq/L is below the normal range (3.5–5.0 mEq/L) and increases the risk
for cardiac dysrhythmias, especially in patients taking digoxin .
Question 3
A nurse is teaching a patient about digoxin therapy. Which statement indicates
understanding?
A) "I will take an extra dose if I miss one."
B) "I can stop taking digoxin if I feel better."
C) "I will check my pulse daily before taking the medication."
D) "I will take digoxin with antacids for stomach upset."
Answer: C
Rationale: A key nursing responsibility is checking the apical pulse for one full minute
before digoxin administration. Bradycardia (pulse <60/min in adults) requires holding
the dose and notifying the provider. Antacids decrease digoxin absorption .
Question 4
A patient with heart failure is prescribed digoxin. Which finding is most indicative of
digoxin toxicity?
A) Heart rate of 68 bpm
B) Serum potassium of 4.0 mEq/L
,C) Visual changes (yellow-green halos)
D) Weight gain of 2 kg in 24 hours
Answer: C
Rationale: Yellow-green halos (xanthopsia) are classic signs of digoxin toxicity . Other
signs include nausea, vomiting, anorexia, and arrhythmias. A heart rate of 68 bpm and a
normal potassium level do not indicate toxicity.
Question 5
A nurse reviews laboratory reports for a client receiving digoxin and furosemide. Which
laboratory values most concern the nurse?
A) K⁺ 4.5 mEq/L, digoxin 1.0 ng/mL
B) K⁺ 3.2 mEq/L, digoxin 2.2 ng/mL
C) Na⁺ 140 mEq/L, digoxin 1.5 ng/mL
D) Mg²⁺ 2.0 mEq/L, digoxin 0.8 ng/mL
Answer: B
Rationale: A digoxin level of 2.2 ng/mL is above the therapeutic range (0.5–2.0 ng/mL)
and considered toxic. Hypokalemia (K⁺ 3.2 mEq/L) further increases the risk of digoxin
toxicity because low potassium potentiates the effects of digoxin on cardiac muscle .
Furosemide causes potassium wasting, making this combination particularly dangerous.
Question 6
A patient is prescribed atorvastatin for hyperlipidemia. Which statement by the patient
indicates a need for further teaching?
, A) "I should have my liver function tested regularly."
B) "I can continue drinking grapefruit juice with my breakfast."
C) "I should report any muscle pain to my doctor."
D) "I will take my medication at the same time each day."
Answer: B
Rationale: Atorvastatin is metabolized by the CYP3A4 enzyme system. Grapefruit juice
inhibits this enzyme, leading to increased blood levels of the drug and a higher risk of
adverse effects like myopathy and rhabdomyolysis . Patients should avoid grapefruit
juice.
Question 7
A nurse is caring for a client receiving IV vancomycin. Which assessment finding requires
immediate intervention?
A) Mild flushing of the neck and face
B) Tinnitus and complaints of hearing loss
C) Serum creatinine of 0.9 mg/dL
D) Infiltration of the IV site with swelling
Answer: B
Rationale: Tinnitus and hearing loss indicate ototoxicity, a serious adverse effect of
vancomycin that can be irreversible . Red Man Syndrome (flushing) is common but
usually managed by slowing the infusion rate. Creatinine 0.9 mg/dL is normal.
